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3. Posture and support

Simple measures to reduce strain on the knee include avoiding chairs that are low to the ground or couches in which the sitter "sinks."

Sitting on a pillow may help with this. Putting a pillow underneath the knees can make the problem worse, however. A good sitting posture is also important.

Shoes that are supportive are helpful. Shoes with broken arches may produce abnormal force and wear on the knee, causing pain.

Long periods without moving should be avoided. In osteoarthritis, for example, prolonged sitting can produce a stiff, painful joint.

4. Weight loss and diet

A Mediterranean diet can help people maintain a healthy weight and may have anti-inflammatory properties.

People who have excess weight or obesity have a higher risk of knee pain.

Carrying extra weight gives the joints more work to do. Losing it helps to reduce long-term knee pain, including pain caused by arthritis.

Extra weight on your body increases inflammation throughout the body and the knees are affected.

Eating well helps with keeping weight off.

A healthful diet means a balanced one that is:

high in fruit, vegetables, and fiber

low in meat, animal fat, and other fat

The Arthritis Foundation recommend a Mediterranean-style diet that is rich in fresh produce.

You should check with a healthcare provider before starting a diet that claims to be good for knee pain, to ensure it will be safe for you.

5. Medications

Non-steroidal anti-inflammatory and other medications can help with knee pain caused by arthritis. Some of these need to be given in a doctor's office, but some can be used at home, either with or without a prescription.

In 2015, researchers published findings after comparing the effectiveness of a number of drugs used to treat knee pain.

They looked at the effects of the following on pain and stiffness:

acetaminophen (Tylenol)

diclofenac

ibuprofen

naproxen

celecoxib

intra-articular corticosteroids

intra-articular hyaluronic acid

They concluded that all of these could be helpful, except for acetaminophen. Intra-articular drugs, those injected into a joint, appeared to be the most effective.

In a study of 1,583 people with osteoarthritis, a combination of glucosamine and chondroitin sulfate has been tested for safety and effectiveness.

The treatment looks promising, as nearly 80 percent of participant reported a reduction in pain of 20 percent or more. People who are interested in this treatment should speak to their doctor about it.

6. Massage

These should be done in a seated position with the knees pointing forward and the feet flat on the floor.

Loosely closing the hands into fists, tap the upper, lower, and middle thigh 10 times with both hands. Repeat three times.

Sitting with the feet flat on the floor, place the heel of the hand on the top of the thigh and glide it as far as the knee, then release. Repeat five times. Do the same for the outer and inner sides of the thigh.

Press four fingers into the knee tissue and move up and down five times. Repeat all around the knee.

Place the palm of the hand on top of the thigh, glide it down the thigh, over the knee and back up the outer thigh.

Massaging the thigh muscles will have a beneficial impact on the knee.

7. Aromatherapy preparations

Essential oils may help reduce pain.

A study published in 2008 suggested that massaging with an oil containing ginger and orange improved pain and function in knees with moderate to severe pain due to osteoarthritis.

In one investigation, researchers found that applying an ointment containing cinnamon, ginger, mastic, and sesame oil had a similar effect on pain, stiffness, and motion as using salicylate ointment.

8. Protection, rest, ice, compression, and elevation (PRICE)

Use compression to support the knee and relieve pain.

Rest, ice, compression, and elevation may help treat mild knee pain that results from a soft tissue injury, such as a sprain.

Protection refers to protecting the knee from further injury, for example, by taking a break from the activity that caused it.

Rest can reduce the risk of further injury and give tissues time to heal. However, stopping all movement is not advisable, as this can lead to stiffness and, in time, muscle weakness.

Ice can help reduce swelling and inflammation. It should be wrapped in a cloth and applied for 20 minutes several times on the first day of injury. Never put ice directly the skin, as this can lead to further damage.

Compression with a knee support, for example, can increase comfort levels. The support or bandage should be firm but not tight.

Elevation, or keeping the leg raised, will encourage circulation and reduce swelling. Ideally, the knee should be above the level of the heart.

10. Climate

Study findings do not support this, although living in a pleasant climate might make pain psychologically easier. It may also provide easier opportunities to achieve a more healthy lifestyle.

In 2014, researchers found that — rather than weather itself — sensitivity to weather in older people with osteoarthritis may affect how they experience joint pain.

People from Southern Europe, women, and those with higher anxiety levels were more likely to report weather sensitivity, and those with higher levels of sensitivity were more likely to report increased pain, especially with damp or rainy and cold weather.

The results of the study did not support the common belief that pain becomes worse in a colder climate.

A 2017 study carried out in the United States supported this view. Findings showed no link between rainfall and increased medical visits for joint pain.

11. Acupuncture

Participants received either 23 true or 23 sham acupuncture sessions over 26 weeks, or 6 acupuncture sessions over 12 weeks.

Those who had true acupuncture scored higher in pain and function scores, compared with the others.

Researchers concluded:

"Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups."

12. Tai chi

Tai chi is a form of meditative exercise, and the benefits of exercise alone are discussed above.

Rheumatoid arthritis

Rheumatoid arthritis tends to involve swelling of the knee. Sore joints will tend to be red, tender, warm, and swollen.

The pain involves more general stiffness that is typically worse in the early morning. There can be afternoon fatigue. Knee pain with these symptoms needs the attention of a doctor for correct diagnosis and treatment. Rheumatoid arthritis benefits from early treatment.

Sprains, strains, and injuries

Sprains and strains happen when tissues in the knee become stretched by unusual or increased activity, or an awkward twist or trip.

PRICE, described above, should lead to a reduction in pain and improved movement within days, and a gradual improvement over the weeks to follow.

A sprain often resolves itself, but some problems can require more treatment. For example, an injury to the pad of tissue in the knee joint known as the meniscus may require surgery.

Gout

Gout is another type of arthritis. It produces sudden episodes of severe knee pain with redness and swelling, and can affect other joints. The condition can be treated under medical care with medication and changes to diet and exercise.

When to see a doctor

An obvious knee injury caused by sudden trauma, such as from a road accident or a fall, may need immediate medical attention.

A knee should be checked by a doctor if there is considerable pain, deep cuts, swelling, or the person is unable to use their leg.

For other cases of knee pain, a doctor will need to examine the problem if it:

persists for a long time

gets progressively worse

disrupts daily activities

It is important to get a diagnosis and treatment from a doctor if knee pain involves red, tender, warm, and swollen joints.

If the symptoms are persistent, involve other joints, and there are other symptoms such as morning stiffness, it could be rheumatoid arthritis. Doctors can give drugs for both the disease itself and the pain it causes.

If a swollen knee is very hot and painful, and if there are other general symptoms of feeling unwell, this is a time to get urgent medical help. The knee could be infected, and serious infection can be dangerous. This needs urgent hospital treatment.

Anyone whose knee pain is receiving medical help should see contact their doctor again if problems get worse or if there are issues with treatment, such as a drug side effect.

Q:

Should I take glucosamine supplements for knee pain?

A:

Glucosamine sulfate has been shown to provide reduction in pain for people with osteoporosis. This may be a good choice for people who are unable to take over the counter nonsteroidal anti-inflammatory drugs (NSAIDs).

There may be some digestive side effects. It is possible to be allergic to glucosamine, especially for people who are allergic to shell fish. Stop using if you develop skin rash or other symptoms of allergy.

Herbs can interfere with medications. Glucosamine should not be taken if you are on blood clotting medications and can interfere with effectiveness of over the counter pain killers.

I think glucosamine sulphate is worth trying for those with chronic knee pain, but tell your doctor so you are sure that it is safe to take.

Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHTAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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